8/13 Simon amps 175, +2 139, +5 129, pmps 227

Yesterday's Thread
Good morning! We skipped the dose last night and Simon's BG was 153 at +3, holding pretty steady this amps at 175. So perhaps a small dose - 0.25? Or not?

 

Good morning. Can you monitor? If you can I am thinking .50.

 

Well you know how effective I am at monitoring but I think we can do it. What intervals would you recommend?

 

Start with a +2. How is his appetite?

 

I think we can handle that. Thank you! He seems less nauseous today so I think he will eat.

 

Don't think you can do it...KNOW you can do it. Get that confidence under you belt. You're helping Simon even though, it feels like you're torturing him.
Plenty of love, scratches, yummy treats and extra big hugs for you. Breathe, relax and shake it off

 

For some reason I am nervous about giving him a dose this morning. I really just want to wean him off insulin as quickly as possible. I guess his body probably needs a smooth glide path down, but I find this drug to be very frightening.

 

Thank you! it is going better each time!

 

The longer you can support the pancreas by giving small amounts of insulin, the stronger the remission. Some cats do fall out of remission.
That is why there is micro-dosing.

 

I seriously think the new vet can’t come soon enough. I think he may need medication changes. If you don’t feel comfortable shooting .50 then try .25. Will your vet give you an RX for ondansetron? It can be given every 8 hours and can even be given in addition to cerenia.

 

What dose of cerenia are you giving?

 

I think I will try 0.5. I really want to support his pancreas to heal, and he has room w/ his numbers right now. Yes, we have ondansetron on the way - for now I am giving him my own zofran rx cut into quarters. Definitely looking forward to a better vet! Will post updates at +2.

 

See you then. What dose of ondansetron and how much does he weigh?

 

Oh Kyle, reading this makes me sad for you! Insulin has been keeping me alive for over 40 years. It's a hormone instead of an actual drug. Yes, it's scary - those lows, but life giving! Monitoring is your safety mechanism . . . taking the kitty slowly down in dose usually makes remission stick better, like has been said.

My Tina has several of your Simon's health issues and health is always a balancing act. People here are so helpful with many health concerns of our elder babies.
When poking for BG checks, I always put my nursing hat on, and told Tina I loved her and poking was a good thing! Treat afterward if it makes either of you feel better!

 

Couldn’t have said it better, Tina. I think the worry is the nausea but we can get that under control.

 

He weighs approx 12 lbs- I have been giving him 2 mg (a quarter of my 8 mg pills) but asked the vet for 1 mg pills so I can dose him more frequently. Did you find ondansetron to be very helpful? I am actually thinking that famotidine seems to settle his stomach at night. Plus I am giving him slippery elm. Cerenia does nothing as far as I can tell but I keep giving it to him b/c its supposed to have anti-inflammatory properties? Sort of feel like I am throwing the kitchen sink at him sometimes!

 

Thank you for your kind words @Tina Marie and Jan! I know insulin is such a miracle for people (and cats) who need it, I am just gaining a new appreciation of how powerful it is! Hormones!!

 

WE are on 4 mg Cerenia.

 

That’s not enough. He needs at least 6 from what I’ve seen on dosing. Let me see if I can find that for you.

 

My source says the Cerenia dose for chemo induced nausea he needs is 1mg per pound. It’s on a vet supervised site but I can’t print it. I would at least try 6-8 mg to see if it helps. Ondansetron dose is .50-1mg per kg. That one you can find posted. The Cerenia one though it’s been given to cats for over 10 years is only officially approved as an injectable but I used it 10 years ago for my angel Tiffany.

 

Yes if you find something let me know. I think some people give 8 mg. There is some debate about negative effects to the liver- perhaps requiring a break in dosing now and then- but it would explain why the 4mg dose does not seem to help much?

 

Wow 1 mg per pound is a lot. Yes 8 sounds like a good next step. Thank you!

 

It absolutely might explain that. Here’s a chart that shows the ondansetron dosing I said above. Ignore the Cerenia part as it’s for dogs.
https://todaysveterinarypractice.co...tes/4/2015/02/MedicationsForAcuteVomiting.pdf

 

If you stick with that drug pulsed doing causing much less nausea and you wouldn’t need to give it as often. Taking a holiday from it is old school thinking. The Cerenia injection works better with a lower dose but it stings. I couldn’t do it to my cats.

I would tell yiur vet the nausea is bad and ask him how much he suggests you increase.

 

Okay well it only took me 25 minutes but I finally got another BG reading! I just couldn't get enough blood- I think I was lancing too far away from the edge of his ear and it was hurting him. I finally hit the right spot, there was a perfect drop, and he didn't seem to feel a thing! It seems to be all about location! 139! I was afraid it would be a lot lower, so I think this is fine for a +2.5?

 

That is a great chart! Thank you so much for sharing.

 

I am asking for the pulsed dose now. I have mentioned the nausea multiple times but she seems pretty blasé about it. I think she graduated from vet school only a few years ago and I not sure she has the experience necessary for a complex situation like this! Most of the time I can't get her to return my calls or respond to my emails. Very frustrating!

 

Testing will get easier. That’s a good number but because it’s lower than the preshot he could be on the move. I would get a test in an hour and feed him a little if he will eat.

 

Well I would definitely increase the Cerenia and see if it helps. It’s a sad state of affairs when us lay people know more than the vets.

 

Roger that! I have an appointment with my local vet a 2pm so we can get a +6 there as well. I really appreciate your holding my hand through all this!!

 

I absolutely hate playing amateur vet. Unfortunately this seems to be a problem in human medicine as well! Luckily there is information- and support- to help us lay people try to do the best we can, but it seems like a lot of responsibility for someone with a degree in Ecology!

 

I so agree!

 

Missed this one. I wouldn’t let her know you are getting advice from the internet except for RX info from veterinary sources. Some vets frown upon internet advice. My internal medicine vet welcomed any input and showed his students my spreadsheet. I once joked with hi, I needed to go back to school to be a tech and he corrected me. No, a vet! This well known man is so open to learn and he’s in his 60’s.

 

Oh, you might have better luck testing using a 25 gauge needle instead of a lancet. Or try free hand if using a device.

 

Well I need to do something different as I just went through my last testing strip and still could not get a good sample. Plus I genuinely hurt Simon, he was yowling at me. So we will have to wait for the vet's reading to get the next BG. Maybe I should go back to the lancing pen? Very frustrated right now!

 

I never used a lancing pen. My vet preferred a needle and taught me that way. I used the very sharp terumo 25 gauge though. I never had to pole more than once. It’s worth a try.

 

https://www.shopmedvet.com/product/terumo-needles-25x1-100-bx

 

I will try it. I will try anything now. I have poked his ears so many times today I think they are very bruised and sore.

 

I think that is what I use for his s-q fluids, so I will try it. Poor kid!

 

I'm sorry the home testing is so hard. I went through test strips like they were water in the beginning, too. I could see every single poke on Butters' ears and they looked terrible. I read your messages and I could have written them about Butters when I was just starting out. You'll get the hang of this.

Has anyone told you that you could use some neosporin ointment (not cream) on his ears to help them heal? I have also used coconut oil and that seems to work, too. I know Simon has a lot going on, so obviously don't take my advice unless you know it would be okay for him (and you want to). It's just what I use for Butters after people here recommended it for me. And you're warming up his ear?

Sorry, it's hard to go back and read through all the messages on home testing from your condo yesterday. I figure it can't hurt if I reiterate a couple of sage pieces of advice I received early on.

I switched to the lansing device and never went back. I rest one edge of it on the cotton pad and the rest of it on her ear. That seems to help me get the right spot. Does it have different settings? Mine has ten and I had to start on the highest setting (5) to get a good blood drop. As I learned to press more firmly, I was able to dial it back to a lower setting.
I think I had too heavy a hand for freehanding it, and Butters let me know. Depends what you and Simon are most comfortable with.

Have a great day, Kyle.

 

Thank you so much for your understanding @Butters & Lyla You are so kind. The vet tech today showed me some tricks that she uses, and I am hopeful they will help me. It was very helpful to watch someone do this in person - much better than trying to watch videos! I will definitely try some neosporin on his poor ears. I know eventually we will figure it out! I so appreciate your support!

 

Just got back from the vet and he felt like w/ Simon's numbers we may be able to ease him off insulin in the next week or so. He did berate me for feeding him a high protein diet given his CKD. He said kidney disease will kill him much faster than diabetes. I guess he has a point there? I told him I was hoping Simon's kidney function would improve if his diabetes was addressed. He sort of gave me a blank stare. Anyway, 129 for +5, feel like we are doing well! Now, to buy some more test strips!

 

It’s true that ff is high in phosphorus but a lower carb diet will get him into remission and then you can work on food. Take a look at tanyascrf.org food chart and see about finding a lower phosphorus but also lower carb food. Lisa Pierson’s list is old but you can find food there and then look on tanyas for the phosphorus info.

 

These are great resources, thank you. Are you going to go back to vet school? I am going to take a break from testing this afternoon. Will you be around this evening for pmps? I have come to rely on you @tiffmaxee!!

 

No more school for me. I’m a retired teacher. I’ll come on to check on you tonight. 8:30 right?
Did your vet have anything to say about dosing? Just curious.

 

He was a substitute vet and seemed really spaced out! He acted like whatever I wanted to do was fine with him?
Yes 8:30, thank you!

 

The idea of feeding a low protein diet to kidney patients is "old school thinking". Sounds like your vet hasn't kept up with the latest research. Restricting protein in the earlier stages of CKD just leads to muscle wasting.

Tanya's site recommends a good quality protein food that's low in phosphorus (and then we need low carb for the diabetes)

Weruva makes a lot of foods that are both low carb and low phosphorus in various flavors and types. They also put their nutritional breakdown right there on their website! It'll cost more than FF but you might buy a few to see how Simon likes them.

China refused to eat anything but FF so when she entered stage 2 so I started using a phosphorus binder. You just mix it into each meal. It's tasteless (so I'm told...I never actually tasted it...LOL)

 

Thank you @Chris & China (GA). I have been reading up on this and am glad Im not hurting Simon w/ a high protein diet. I did order a sample pack of Weruva a while ago, but it turned out most of the flavors were chicken which really seems to exacerbate Simon's IBD. He didn't like the lamb flavor either. I honestly have so much cat food that he doesn't like or that Ive realized isn't good for him in my house right now! Stella & Chewy, Primal, Tiki Cat, Weruva, Royal & Canin GI diet, Hills wet food K/D diet, etc. I should open a cat food store! Luckily he doesn't refuse FF - even when he is not eating well he will at least nibble at it. I will have to look into the phosphorous binder- thank you!

 

Ok pmps 227. I may have let him eat a bit too close to this test. Not what I hoped but at least I finally got that sample. Im thinking 0.5?

 

Do you have a copy of his most recent labs? What was his phosphorus?
Looks like a safe number for you to shoot. You okay with that?

 

Yes 0.5 If possible get a +2.5 or 3.

 

Okay thank you! The vet tech showed me how to use the syringe needle today and she made it look so easy! Unfortunately I could not replicate it here at home! Went back to the lancing device and finally got a sample after 5-6 trys. Poor Simon's ears look like a war zone!
His phosphorous as of last week was 4.9 so I think we are still in a good range.
Thank you @tiffmaxee !

 

I looked on your ss and don’t see the phosphorus level. You would only start a binder, alimony hydroxide, if it is over 5.

 

We cross posted. It will get easier to test. I promise. Sounds like Simon is a real good patient.

 

I haven't added all the data yet, but I will. Yes I think we are still okay on phosphorous. I am really hoping we can get him back to stage 2 kd as his numbers are borderline right now. Do you think his kidneys can improve if his bg is well regulated?

Yes, he is the best most patient cat. His sister Daisy who passed away last year would have absolutely killed me for this!

 

It’s hard to say. I do think that while a very low protein diet is not needed and is old thinking, It’s a good idea to feed quality protein but try to find a lower phosphorus food than fancy feast. If you can’t find one he likes, them you can add a binder if he get his phosphorus rises to 6. Some cats stay where he is which is good for years. Its hard to find a food that works for diabetes. kidney, and IBD. Did you ever try a novel protein, ond gd gas never had before for the IBD?

 

It has been hard to do a lot of food experimenting while he is so nauseous and doesn't want to eat. I did buy some Primal rabbit nuggets (raw) and Stella & Chewy's duck/goose (freeze dried raw), which would both be novel for him, but then I decided these foods aren't prudent based on the phosphorous content. I started searing steaks for him (not a novel protein) and he really seemed to like that, so I was going to buy the EZ complete supplement and try home cooking for him, but then he stopped liking the steak. I think once/if he gets his appetite back we will be able to make a lot more progress with his diet. The only real step forward Ive made is realizing that chicken/turkey are triggers for him. We have only been dealing with this for ~ 6 mos. so it is still a steep learning curve!

 

Yes. Once the nausea s gone it will be much easier. Did you ask the vet about Cerenia dosing? EZ Complete is a good way to go. You can then buy your own protein at a Sprouts. It’s lower phosphorus because it doesn’t contain bone. Just one problem. It contains chicken liver. So I can’t use it for one of mine because she has skin allergies and I’m pretty sure chicken is one she can’t eat. I feed her Primal venison right now. I also use a Small Batch rabbit and lamb.

 

I used to cook for our husky and she loved it! Darn, chicken liver? Well maybe the liver at least wouldn't bother him. I like the idea of buying him high quality protein. Sprouts? I don't think we have one of those within a 3 hour radius of here! But Im sure I could find something nice at our Coop? I didn't ask the vet today about Cerenia- I mostly use the local vet for labs so we don't have to drive, then the Chico vet for meds, and hopefully soon my specialist vet for expert guidance and advice